11 ms·

The efficacy of drugs, specifically Lexapro, on my anxiety cannot be understated. I had attempted lots of different "mindfulness" techniques and other types of

The efficacy of drugs, specifically Lexapro, on my anxiety cannot be understated. I had attempted lots of different "mindfulness" techniques and other types of talk therapy. They seemed like they worked, sorta, at the time. But being on Lexapro is so night and day different that it makes all those other attempts clearly an exercise in futility. Like with everything, if you can't tell it's working, it's not working. Stop guessing. Go talk to your doctor.

0xcde4c3db 9y ago
Also talk to your doctor because mood disruptions can be symptoms of non-psychiatric disorders that call for their own specific treatments. If you're depressed because of something like hypothyroidism, hypogonadism, or sleep apnea, skipping the diagnostic process and going straight to psychotherapy is just going to mask the underlying issue.
moh_maya 9y ago
This! I parrot this on every thread that is remotely relevant. Depression and anxiety are complex problems that are incredibly personal (in the sense that they are unique to the individual). More so than most other disorders. Ergo: 1) No off the shelf solution like popping an ibuprofen for body aches 2) what works for others may not work for you 3) one needs to try multiple solutions 4) and most important, have a professional at your side to guide you! You may not necessarily figure out how to navigate this on your own.
- AnIdiotOnTheNet 9y ago
  On the other hand, having lived most of my life in varying states of depression and having seen doctors when it was at its worst and I was diagnosed with major clinical depression, it is my considered opinion that treating depression is one of those things that doctors are really crap at. The problem seems to me to be that they have a high confidence in a model that isn't very good. Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause.
  - spuz 9y ago
    > Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause. This is obviously not true for some people. If you have a genetic condition that means you cannot produce certain essential chemicals (let's say Vitamin D) and your deficiency is causing your brain to function inefficiently making you feel depressed then the genetic condition is the cause and the drugs are the cure. You seem to be refuting "what works for you might not work for others" by saying that drugs cannot treat the underlying cause of depression.
  - moh_maya 9y ago
    So I agree that there's been a move away from "low seretonin == depression" and the model that depression is due to low seretonin (if it was even in favour), is giving way to "it's much more complex. We don't understand too well". [1] And, there is an argument that is made that such drugs aren't effective anyway (or no more than placebo). However, I think that's an over simplification [2]. And I don't necessarily accept the contention that SSRIs / SNRIs and others just treat symptoms. This goes back to what I was saying earlier, that what works for person X may not work for person Y, not because the treatment isn't effective by itself, but because the etiologies may be different. All the way from a single SNP (single nucleotide polymorphism)) introducing a subtle amino acid substitution in a receptor on the cell surface to the cause being due to a vitamin deficiency (B-complex, for instance, or vit D, as another comment mentioned, or low Mg levels!) to psychological trauma. There are so many reasons that can lead to depression & anxiety. It's like fever. Some fevers can be treated with Tylenol. Others will need quinine, and Tylenol in such a case would be ineffective. What it also means is that we need to find better therapeutic targets in addition to seretonin / dopamine receptors, etc., and maybe move to a combinatorial drug approach once the targets are identified & validated. (like is used in oncology). So please do not dismiss drugs. Or therapy. Or CBT. Or lifestyle changes (diet, exercise). Environmental changes (job, social circle). It could be any of these that can help someone deal with, navigate through and resolve depression. And it can be frustrating to try and narrow down among these. But that's the nature of the beast :/. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ [2] http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...
jdietrich 9y ago
>Stop guessing. Go talk to your doctor. Your doctor will also guess. There are about 20 drug treatments and a dozen or so talk therapies that are all about equally effective at treating depression and anxiety. We have no evidence-based way of figuring out which treatment will work better for which patient. It's a total crapshoot, even for psychiatrists. Anecdotally, escitalopram worked for you. A thirty second Google search will turn up hundreds of anecdotal reports saying that escitalopram is worse than the devil incarnate. The evidence says that it's no better or worse than a laundry-list of other treatments. You got lucky. With that said, talking to your doctor is a sensible decision.
- Domenic_S 9y ago
  I don't understand your point. Surely approaching a solution, even after a few false starts, is better than unmitigated suffering. Besides, there's family history to consider, which may help rule out some drugs. The doc isn't always going in totally blind.

0xcde4c3db 9y ago

Also talk to your doctor because mood disruptions can be symptoms of non-psychiatric disorders that call for their own specific treatments. If you're depressed because of something like hypothyroidism, hypogonadism, or sleep apnea, skipping the diagnostic process and going straight to psychotherapy is just going to mask the underlying issue.

moh_maya 9y ago

This! I parrot this on every thread that is remotely relevant. Depression and anxiety are complex problems that are incredibly personal (in the sense that they are unique to the individual). More so than most other disorders. Ergo: 1) No off the shelf solution like popping an ibuprofen for body aches 2) what works for others may not work for you 3) one needs to try multiple solutions 4) and most important, have a professional at your side to guide you! You may not necessarily figure out how to navigate this on your own.

AnIdiotOnTheNet 9y ago
On the other hand, having lived most of my life in varying states of depression and having seen doctors when it was at its worst and I was diagnosed with major clinical depression, it is my considered opinion that treating depression is one of those things that doctors are really crap at. The problem seems to me to be that they have a high confidence in a model that isn't very good. Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause.
- spuz 9y ago
  > Which isn't to say that drugs can't help, just that they're very much treating the symptoms and not at all the underlying cause. This is obviously not true for some people. If you have a genetic condition that means you cannot produce certain essential chemicals (let's say Vitamin D) and your deficiency is causing your brain to function inefficiently making you feel depressed then the genetic condition is the cause and the drugs are the cure. You seem to be refuting "what works for you might not work for others" by saying that drugs cannot treat the underlying cause of depression.
- moh_maya 9y ago
  So I agree that there's been a move away from "low seretonin == depression" and the model that depression is due to low seretonin (if it was even in favour), is giving way to "it's much more complex. We don't understand too well". [1] And, there is an argument that is made that such drugs aren't effective anyway (or no more than placebo). However, I think that's an over simplification [2]. And I don't necessarily accept the contention that SSRIs / SNRIs and others just treat symptoms. This goes back to what I was saying earlier, that what works for person X may not work for person Y, not because the treatment isn't effective by itself, but because the etiologies may be different. All the way from a single SNP (single nucleotide polymorphism)) introducing a subtle amino acid substitution in a receptor on the cell surface to the cause being due to a vitamin deficiency (B-complex, for instance, or vit D, as another comment mentioned, or low Mg levels!) to psychological trauma. There are so many reasons that can lead to depression & anxiety. It's like fever. Some fevers can be treated with Tylenol. Others will need quinine, and Tylenol in such a case would be ineffective. What it also means is that we need to find better therapeutic targets in addition to seretonin / dopamine receptors, etc., and maybe move to a combinatorial drug approach once the targets are identified & validated. (like is used in oncology). So please do not dismiss drugs. Or therapy. Or CBT. Or lifestyle changes (diet, exercise). Environmental changes (job, social circle). It could be any of these that can help someone deal with, navigate through and resolve depression. And it can be frustrating to try and narrow down among these. But that's the nature of the beast :/. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/ [2] http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

jdietrich 9y ago

>Stop guessing. Go talk to your doctor. Your doctor will also guess. There are about 20 drug treatments and a dozen or so talk therapies that are all about equally effective at treating depression and anxiety. We have no evidence-based way of figuring out which treatment will work better for which patient. It's a total crapshoot, even for psychiatrists. Anecdotally, escitalopram worked for you. A thirty second Google search will turn up hundreds of anecdotal reports saying that escitalopram is worse than the devil incarnate. The evidence says that it's no better or worse than a laundry-list of other treatments. You got lucky. With that said, talking to your doctor is a sensible decision.

Domenic_S 9y ago
I don't understand your point. Surely approaching a solution, even after a few false starts, is better than unmitigated suffering. Besides, there's family history to consider, which may help rule out some drugs. The doc isn't always going in totally blind.